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Finasteride mainly prevents further hair loss by blocking DHT but doesn't reverse existing damage, while minoxidil can promote regrowth by waking dormant follicles. Ketoconazole helps with inflammation, but none of these treatments can reverse fibrosis or structural changes around hair follicles.

The user has been using finasteride for hair loss since January 2023, initially seeing improvement but now experiencing increased thinning. They are considering other factors like thyroid and insulin resistance and are seeking advice from long-term finasteride users, while some suggest trying dutasteride, minoxidil, or consulting a dermatologist for further evaluation.

The conversation discusses hair loss treatments, focusing on insulin resistance, microneedling with topical melatonin, and stress reduction. Users express skepticism about the advice, preferring proven treatments like minoxidil and finasteride, while some mention alternative methods like dermal incisions and verteporfin for reducing fibrosis.

PP405 is the most promising future treatment for hair loss, aiming to reactivate dormant hair follicles. Clascoterone 5% is the most promising near-term drug, while current strategies include using finasteride or dutasteride to stabilize hair loss and minoxidil to stimulate growth.

Topical pirfenidone is highlighted as an effective anti-inflammatory and anti-fibrotic treatment for hair loss, particularly in addressing perifollicular fibrosis, which may enhance the effectiveness of standard treatments like finasteride and minoxidil. The user also uses calcipotriol, MCT oil, ciclopirox shampoo, and benzoyl peroxide shampoo as part of their regimen.